Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study.

IF 2.8 3区 医学 Q1 ORTHOPEDICS
Ahmet Müçteba Yıldırım, Serkan Bayram, Taha Kizilkurt, Nur Canbolat, Mehmet Barış Baslo, Mehmet Aşik
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引用次数: 0

Abstract

Background: We aimed to investigate the compression and ischemic effects of two different tourniquet pressures on tissues during surgery show a clinical difference.

Methods: Patients aged 18-65 years who underwent foot and ankle surgery and applied a tourniquet in a single center between September 2022 and November 2023 were included in this prospective randomized study. Accordingly, tourniquet pressures were applied as limb occlusion pressure (LOP) + 50 mmHg in group 1 (12 patients) and LOP + 100 mmHg in group 2 (12 patients). The time point at which the femoral nerve motor evoked potential (MEP) decreased by 50%, the time point at which the MEP decreased by 100% for all nerves (femoral, tibial, and deep peroneal), and the time point at which all responses returned after the tourniquet was deflated were identified as the time points for analysis.

Results: There were no differences in demographic data (age, body mass index, and sex) between the two groups. The mean tourniquet pressure was 191 ± 16 mmHg in Group 1 and 247 ± 21 mmHg in Group 2 (p < 0.001). A 50% decrease in the femoral nerve MEP value was observed at an average of 47 min in Group 1 and 34 min in Group 2 (p < 0.001). A complete loss of MEP responses for all nerves was observed at an average of 69 min in Group 1 and 56 min in Group 2. After the tourniquet was deflated, all MEP responses returned to baseline values at an average of 8.5 min in Group 1 and 12.6 min in Group 2 (p = 0.007). The results showed that lower limb nerve innervation was affected later and returned to normal earlier after deflation of the tourniquet in Group 1 (low tourniquet pressure group).

Conclusions: The innervations of the lower extremity nerves were affected later in the group in which low tourniquet pressure was applied (average 191 mmHg). Again, in this group (LOP + 50 mmHg), nerve conduction recovered an average of 10 min after deflation and four minutes earlier than in the high tourniquet pressure group.

Level of evidence: Level I, diagnostic study.

Trial registration: NCT05926154.

低止血带压力对下肢神经支配的影响较小:通过随机对照研究比较不同止血带压力与术中神经监测。
背景:我们旨在研究两种不同止血带压力在手术过程中对组织的压迫和缺血效应是否存在临床差异:这项前瞻性随机研究纳入了 2022 年 9 月至 2023 年 11 月期间在一个中心接受足踝手术并使用止血带的 18-65 岁患者。因此,止血带压力在第一组(12 名患者)中为肢体闭塞压力(LOP)+ 50 mmHg,在第二组(12 名患者)中为 LOP + 100 mmHg。股神经运动诱发电位(MEP)下降 50%的时间点、所有神经(股神经、胫神经和腓深神经)运动诱发电位下降 100%的时间点以及止血带放气后所有反应恢复的时间点被确定为分析时间点:结果:两组的人口统计学数据(年龄、体重指数和性别)无差异。第一组的平均止血带压力为 191 ± 16 mmHg,第二组为 247 ± 21 mmHg(p 结论:第一组的平均止血带压力为 191 ± 16 mmHg,第二组为 247 ± 21 mmHg:在使用低止血带压力(平均 191 mmHg)的组别中,下肢神经的支配较晚受到影响。同样,在该组(LOP + 50 mmHg)中,神经传导在放气后平均 10 分钟恢复,比止血带压力高的组早 4 分钟:证据级别:I级,诊断性研究:试验注册:NCT05926154。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.10
自引率
7.70%
发文量
494
审稿时长
>12 weeks
期刊介绍: Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.
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